Provider Demographics
NPI:1841727484
Name:GERENA, KAREN (TEACHER)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GERENA
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2039
Mailing Address - Country:US
Mailing Address - Phone:631-474-5841
Mailing Address - Fax:
Practice Address - Street 1:58 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2039
Practice Address - Country:US
Practice Address - Phone:631-474-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist